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National Renal Pathology E.Q.A. Scheme

Circulation G


This document gives information on individual cases in circulation G of this scheme. It contains no personal details of participants.

Cases included:

G 176
G 177
G 178
G 179
G 180
G 181
End


A click on the {Image} icon should provide an image from the material circulated. Some of the images are composites - remember to scroll the image to see parts beyond the bottom of your screen.

WARNING The image files associated with this document are selected by the Organiser in an attempt to illustrate the relevant features of the material which was circulated in the EQA scheme. They are intended as an 'aide memoire' for participants who may no longer have the slides for review.

They are NOT intended as 'good examples' or as teaching material. Some of the images may be chosen to illustrate a feature which led some participants to a wrong diagnosis.


Case Response Analysis

Circulation: G

Case number: 176 .... {Image}


Number of responses:66 . Date of analysis: 19 DEC 01

Clinical:

6 weeks old Arab female with congenital nephrotic syndrome and bilateral retinal detachment. IF not performed.

Specimen:

H&E, EM x1
Diagnostic categories:                         Score:
 1  Congenital nephrotic syndrome, Finnish type             3.67
 2  CNS, diffuse mesangial sclerosis type                   2.88
 3  Crescentic glomerulonephritis                           1.33
 4  Alport syndrome                                         0.61
 5  CNS, not typical of Finnish or DMS                      0.30
 6  CNS, mesangial proliferative pattern                    0.15
 7  Juvenile nephronophthisis                               0.15
 8  Congenital nephrotic syndrome NOS                       0.61
 9  Consequence of consanguinous parents                    0.15
 10 Anti-GBM disease                                        0.15

Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 3.67

Secondary diagnoses and comments (if any):

Suitable for EQA?*6. (Several short essays received from paediatric nephropathologists!) Would seek specialist opinion*9. ANCA and anti-GBM*1. Exclude CMV*2. Silver*1. Masson trichrome*1. EM*1. More clincal info (placental weight etc.)*3.

Original report and further information (if any):

Crescentic glomerulonephritis, pauci-immune, developing in microcystic disease - Congential nephrotic syndrome of Finnish type.


Circulation: G

Case number: 177 .... {Image}


Number of responses:71 . Date of analysis: 19 DEC 01

Clinical:

29 y.o. woman with recurrent haematuria, proteinuria 4.4gms, creatinine clearance 62ml/min. IF showed IgG-, IgA++ (mesangial), C3 non-specific, fibrin -.

Specimen:

H&E, PAS, one print of IF for IgA
Diagnostic categories:                         Score:
 1  IgA nephropathy/HSP                                     10.00

Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 10.00

Secondary diagnoses and comments (if any):

ANCA*3. EM*3. Repeat IF*1. Exclude vasculitis *1. ASOT*1. Lupus serology*2. IgA AND vasculitis - 2 diseases??*1 ( N.B. Many later participants complained of not receiving image of IgA - but no disagreement on diagnosis!)

Original report and further information (if any):

IgA nephropathy.


Circulation: G

Case number: 178 .... {Image}


Number of responses:70 . Date of analysis: 19 DEC 01

Clinical:

53 year old male, presented with nephrotic syndrome. Longstanding diabetes mellitus. IF probably non-contributory; some granular mesangial IgM and linear IgA.

Specimen:

H&E, images of PAS and silver, EM x2
Diagnostic categories:                         Score:
 1  Diabetic glomerulopathy                                 8.29
 2  Diffuse proliferative Gn                                0.17
 3  Diabetes AND proliferative Gn                           0.71
 4  Light chain nephropathy                                 0.24
 5  MCGn type I                                             0.43
 6  Amyloid                                                 0.01
 7  MPGn type II but ?diabetes too                          0.14

Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 8.29

Secondary diagnoses and comments (if any):

ATN too*1. Congo red*3. Light chain IF*5. ?ASOT*1. PAS*1. Congo red*1. Silver*1. Cellular glomeruli - Gn too?*1. Cellular glomeruli but not Gn*1.

Original report and further information (if any):

Diabetic glomerulopathy. Subsequent gradual deterioration in renal function.


Circulation: G

Case number: 179 .... {Image}


Number of responses:71 . Date of analysis: 19 DEC 01

Clinical:

male, 68, progressive renal impairment over days, creatinine 350, pANCA positive, MPO>1000, complains of myalgia, night sweats. History of peripheral vascular disease. IF: flecks of IgM and C3 in glomeruli.

Specimen:

H&E, PAS, silver
Diagnostic categories:                         Score:
 1  Necrotising glomerulonephritis / vasculitis             6.87
 2  Definite Wegener's                                      1.13
 3  Definite PAN / polyangiitis                             1.31
 4  Proliferative glomerulonephritis ?cryo.                 0.14
 5  SLE                                                     0.14
 6  Myeloma                                                 0.18
 7  Lymphoma                                                0.08
 8  Acute interstitial nephritis                            0.14

Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 6.87

Secondary diagnoses and comments (if any):

Secondary interstitial nephritis*13. Exclude myeloma / k&l stains*6. Exclude lymphoma*4. ?cryoglobulinaemia*1. ?also pyelonephritis*1. EVG*1. EM*1. Granulomas - do Z-N*1. Already treated??*2.

Original report and further information (if any):

Pauci-immune crescentic glomerulonephritis consistent with microscopic polyarteritis.


Circulation: G

Case number: 180 .... {Image}


Number of responses:71 . Date of analysis: 19 DEC 01

Clinical:

63y.o. female. Presenting in renal failure with macroscopic haematuria, dialysis dependent. Immunology including anti-GBM antibodies negative. History of previous extensive DVT.

Specimen:

H&E, PAS
Diagnostic categories:                         Score:
 1  Crescentic glomerulonephritis NOS                       9.30
 2  Proliferative Gn NOS with crescents                     0.28
 3  MPGn type 1 with crescents                              0.14
 4  Microscopic polyangiitis                                0.14
 5  Rhabdomyolysis and ATN                                  0.07
 6  Post-infectious Gn                                      0.07

Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 9.30

Secondary diagnoses and comments (if any):

ANCA?*8. Immuno (? pauci-immune?)*23. EM*10. ?hypertensive*1. ?malignancy* 2. ?coagulopathy*1. ?antiphospholipid*2. Haemosiderosis*2. (NB DVT - anticoagulated?) ?cryo*1. ? myeloma*1. ?Behcet's*1. ?systemic sclerosis* 1. ? lupus*3. Exclude renal vein thrombosis*3. Drugs?*1. Inadequate for EQA without IF*2. Congo red*1.

Original report and further information (if any):

Necrotising crescentic glomerulonephritis. Serology (for SLE, anti-GBM, ANCA) all negative. History of chest infection and pleural effusion.


Circulation: G

Case number: 181 .... {Image}


Number of responses:67 . Date of analysis: 19 DEC 01

Clinical:

SLE diagnosed 1996. Blood and protein on dipstick. Creatinine 69. ?grade of renal involvement. Diagnosis is SLE; please grade activity by WHO scheme. (To be discussed by Dr I. Roberts at Participants' Meeting

Specimen:

H&E, silver, EM x1

Macro:

DIAGNOSIS IS SLE: PLEASE GRADE ACTIVITY.
Diagnostic categories:                         Score:
 1  WHO I                                                   0.00
 2  WHO II                                                  0.15
 3  WHO III                                                 7.09
 4  WHO IV                                                  2.45
 5  WHO V                                                   0.01
 6  Other grading system used                               0.30

Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 3 with 7.09

Secondary diagnoses and comments (if any):

More EM*1. Activity index (score out of 24): 3; 4; 7; 8; 8; 8; 10; 10; 11; 11; 11; 14. Activity 4; 4; 5; 7; 7; 9; B; 10/2; I don't use scoring systems*3

Original report and further information (if any):

Lupus nephritis: focal proliferative glomerulonephritis, WHO III


Links to cases in this document:
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G 176
G 177
G 178
G 179
G 180
G 181



Last updated: 19 DEC 01
Organiser: Dr Peter Furness, PhD, FRCPath. Department of Pathology,
Clinical Sciences Building,
Leicester Royal Infirmary,
P. O. Box 65,
Leicester, U.K.
Tel: (0116)2584582
Fax: (0116) 2584573

Email: pnf1@le.ac.uk